OVERVIEW

Trichotillomania (pronounced: trik-oh-till-oh-may-nee-ah) is officially classified as an impulse control disorder that involves strong urges to pull out one’s own hair. The most commonly targeted area is the scalp, followed by the eyelashes, eyebrows, and pubic region. While most people with trichotillomania pluck each hair out at the roots, others may pull out large handfuls at a time. Hairs with unique textures or qualities may be preferred. The pulling may include rituals, such as twirling hair off or examining the root. Half of those individuals with trichotillomania engage in oral behaviors—running hair across the lips or through the teeth, biting off the root (trichophagy), or eating hair (trichophagia). Symptoms may come and go for weeks, months, or years at a time.

DEMOGRAPHICS

Due to social implications, trichotillomania often goes unreported, making it difficult to accurately predict its prevalence. It is estimated that the disorder affects 2-4% of the population, or two to ten million Americans. By adulthood, 80-90% of reported cases are women, though it seems to effect both genders equally throughout childhood.

SYMPTOMS

According to the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV-TR), produced by the American Psychiatric Association… the following conditions must be present for a diagnosis of trich:

• noticeable hair loss (alopecia) due to recurrent hair-pulling
• tension immediately before hair-pulling, or when attempting to resist hair-pulling [this requirement is controversial because 17% of people who otherwise qualify for this diagnosis do not experience this]
• reduction of tension, or a feeling of pleasure or gratification, immediately following hair-pulling
• significant distress or impairment in social, occupational, or other important areas of functioning
• In addition, the DSM-IV-TR requires that hair-pulling not be due to another medical or mental disorder

POSSIBLE CAUSES

Biology

One theory on a biological level is that there is some disruption in the system involving one of the chemical messengers between the nerve cells in parts of the brain. There may be also a combination of factors such as a genetic predisposition and an aggravating stress or circumstance; as with many other illnesses. Further, trichotillomania could be a symptom caused by different factors in different individuals just as a cough can be produced by a multitude of different medical problems.

OCD

For many people with trichotillomania, there are symptoms of obsessive-compulsive disorder (OCD) such as compulsive counting, checking, or washing as well. There are so many similarities between hair pulling and other compulsive symptoms that some consider it a subtype or variant of OCD. This idea is supported by the tendency for the two problems to run in the same families and the fact that OCD medications can be helpful in treating trichotillomania.

Tourettes

The phenomenology of trichotillomania is variable across patients, but some common elements have been documented. Negative affective states and sedentary or contemplative activities are cues that often prompt or exacerbate hair pulling. Trichotillomania also appears closely related to Gilles de la Tourette’s syndrome. Hair pulling and tics are both involuntary repetitive behaviors that reduce discomfort and tension. Both have impulsive as well as compulsive elements, and neither occurs in response to obsessive thoughts. Trichotillomania and Tourette’s syndrome are disorders that possibly fall on a spectrum of obsessive-compulsive-related disorders. This spectrum of disorders is characterized by similar phenomenological presentations, comorbidity of the disorders, and neurobiological underpinnings. Recent evidence suggests that trichotillomania may respond better to treatment for Tourette’s syndrome than it does to treatment for obsessive-compulsive disorder.

Depression

Depression also frequently occurs in individuals with this illness. There may be a direct neuro-biochemical relationship and/or be secondary to the chronic demoralization and low self esteem hair-pulling can bring.

SOURCES

• http://www.trich.org
• http://kidshealth.org/teen/your_mind/mental_health/trichotillomania.html
• http://www.minddisorders.com/Py-Z/Trichotillomania.html
• http://psy.psychiatryonline.org/cgi/content/full/43/5/429
• http://www.webmd.com/anxiety-panic/guide/trichotillomania
• http://www.nmha.org/go/information/get-info/trichotillomania